Laryngopharyngeal Reflux w/ Dr. Inna Husain | BackTable ENT Podcast Ep. 83
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- čas přidán 2. 01. 2023
- In this episode of BackTable ENT, Dr. Ashley Agan interviews laryngologist Dr. Inna Husain about diagnosis, treatment, and multidisciplinary care of patients with laryngopharyngeal reflux (LPR).
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SHOW NOTES
First, Dr. Husain defines LPR as acidic and/or non-acidic reflux that causes direct and indirect effects on the upper aerodigestive system. She emphasizes the importance of utilizing subclassifications of LPR and explains the difference between direct acid, direct non-acid, and indirect acid reflux. She notes that each subclassification has different treatment patterns and that overlapping diagnoses can make classification difficult. Another challenge in diagnosing LPR is the need to distinguish chronic problems from isolated episodes. If a patient’s LPR is chronic, she suspects the indirect acid LPR subclassification.
During her primary visit with a patient, she asks key questions related to the root problem or sensation a patient is experiencing, such as mucus dripping, throat clearing, or globus. She notes the frequency and severity of their episodes. She also explains that unilaterality of sensation is unlikely to be LPR, and patients correctly diagnosed with GERD commonly have LPR. After taking an initial patient history, she utilizes flexible laryngoscopy to visualize the throat and rule out other diagnoses, such as polyps or tumors. She notes that she will not be able to see reflux through laryngoscopy, but just signs of throat irritation. Additionally, because there is not one defining visual characteristic of LPR, the imaging results are always interpreted through subjective means; thus, LPR is a diagnosis of exclusion.
For patients suspected to have LPR, Dr. Husain initiates empirical medical therapy. She explains to all her patients lifestyle modifications like cessation of smoking / vaping and reduction of coffee, late night eating, carbonated water, and citric foods. Although the conventional treatment of LPR is acid suppression, she only prescribes patients with proton pump inhibitors if they have acid reflux symptoms because 50% of LPR patients don’t actually improve on the medication. Her PPI regime consists of 40 mg omeprazole in the morning and Pepcid at night for 1-2 months. If patients improve, she slowly tapers them off of the PPI to avoid rebound reflux. If the patients do not improve after 2 months, she will switch to another medication, such as alginate suspensions, a more natural alternative to PPI. Alginate suspensions create a barrier that prevents the upward movement of acid. Contraindications include concurrent use with other acid suppression medications and a history of lower GI issues.
Finally, Dr. Husain discusses the 24-hour pH impedance testing, which is the gold standard for LPR diagnosis. A catheter with a probe is inserted into the patient’s throat and sends continuous pH readings to a monitor the patient carries. Patients return after 24 hours, and she is able to find correlations between patient symptoms and acid reflux and classify the LPR subtype. If she interprets any distal esophageal issues or dysmotility issues, she involves her GI colleagues to explore endoscopic solutions. She ends the episode by explaining her treatment regimen for refractory neurosensory (indirect) reflux, which includes neuromodulators (gabapentin, amitriptyline) or a superior laryngeal nerve block.
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RESOURCES
Dr. Husain’s Twitter:
/ drinnahusain
Dr. Husain’s Instagram:
@innahusainmd
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Honestly you can do all of this but you need to address the underlying cause. I did all of the lifestyle changes and it made minimal difference until I had surgery.
I brought up LPR, etc., to the ENT, and she looked at me like I was crazy! I feel some of these doctors don't want to learn new things and think they know it all. I was trying to provide her history and context, but she could not care less what I had to say. She did the procedure where she stuck the camera down your nose and said you must see a gastrologist. I am having an endoscopy in a week and hoping for good results. ALL my symptoms or those listed under LPR. I was miserable for 2 months, and after 31 days of cutting everything! I am doing a bit better out of my diet (lost 11 pounds during) and taking a different PPI. However, this ugly, deep-seated cough is what is driving me and everyone around me insane. I still cough every morning, and after I eat, I tried incorporating a couple of things back into my diet this weekend but realized it was best to not eat it. I ordered a Food Intolerance test to at least see what foods I am super sensitive to, so I can avoid them. What sucks is that I have had problems on and off for years, and the doctors always just said, take an antacid. They never educate you on how serious it can get if you don't change your diet, etc. Praying myself and anyone going through this find relief. I used to work out 3-5 days a week, but now I haven't even gone because I am so miserable.
Try 28 day meal plan it works well for cought❤, I wish soon u will be good 👍
@@amuthugowri5726 thank you!0
Neutralise the pepsin in your throat twice daily by inhaling alkaline water from a facial streamer. It works brilliantly! I have tried everything and done a huge amount of research into LPR over the years.
What kind of facial steamer?
What you said at .....12:31....is so important and beneficial to "us" the patients. I have such a hard time explaining what I'm feeling during different parts of the day and after eating meals. I don't know if my GI is really asking the right questions. I almost need a list of descriptions and then I could point to that and say "That is what I think I'm feeling" it is tough sometimes to know what feeling is coming from where, and how to describe it.
Thank you. Very thorough. It's a frustrating issue to have.
Incredibly informative. Thank you🙏
Thank you!
Very helpful. Thank you.
Thank you for this, now I understand better LPR. My ENT never explained anything of this to me.
Thank you for listening!
What helped me was intermittent fasting, eating lots of green vegetables, salads snd protein size of my palm, and water. I would eat at noon and 6pm... i was drinking ACV in the morning in water... taking supplements and I quit coughing... it was great for months, then I started coughing and one night I coughed my head off ... went to dr... Covid Pneumonia.... got over that... its been hard getting back to before I got it.
And now I am having the mucus issue. coughing is different from the coughing before.
so I dont know if this is LP S this round.
I had an episode last year in April and it took me about 3-4 months to calm down. Had a flare up in December and same week got COVID. I still have to clear my throat after I eat, but taking way longer to clear as I believe the COVID inflamed the Lyrax with the Reflux and made it way worse. You might take a bit longer to recover after your bout with COVID.
I had covid pneumonia. I was on steroids and finished my therapy. Still had a lingering fluctuating shortness of breath that would come n go. I had to stop working out. That lasted a whole year. I decided I wanted to recover and started slowly building up my lungs again. Took natural supplements for my lungs bought it off of Amazon . Name is called breath. I would do breathing exercises. And started walking and eventually was running. You got this . Be patient with your recovery. Love your body and health journey ❤ God bless.
Gargling with bicarbonate if soda is very helpful for me
Red apples cured my acid reflux.
@@rodrigobalibalita12 I have been living off of bananas
@@rodrigobalibalita12how did you heal it. Just eating apples everyday? Please explain because I'm really trying everything I can to heal this 😢
@@rodrigobalibalita12 just eating raw apples???
Very informative 🙏🙏
Excellent video and hugely eye opening, thank you so much. I have had a sore throat, on the left side only, for 6 months and a local ENT prescribed PPI's, of course. Fast foreword, I still have it after trying the alginate and Pepcid. I heard you mention that if the throat pain is one sided only that it may be another cause, could you please elaborate? Thank you
I have the same thing... Did you ever figure out what's the right treatment? Any information would be appreciated!
My ent said it was acid reflux sent me to the gastroenterologist I got a hiatus hernia put me on 40mg trustan this has helped me a lot
I have it only in the right side of the throat, but I do have all the 5 symptoms: chronic cough, throat clearing, hoarsness, sinusisitis. Many years of PPIs treatment without much success. Now diagnosed with sulcusus vocalis. So, is the nature neurogenic or is it LPR?
Hi sir I have ENS please help me
What i do take prp injection or cartilage implant which treatment i take please help me
I respond to both amitriptiline and PPIs. What does this mean?
❤ It. Thanks for sharing informations. God Bless.
Thanks for listening!
I've had acid reflux or more what I believe to be LPR for about a year and a half. Sadly I can't find a doctor that specializes in my area of Canada. Thank you for this very informative podcast. I am very grateful for all that I've learned!
How r u know?
I hope you already found a cure for your acid reflux. If not, you may try natural remedies such as red apple delicious or Fuji apples fruits. My wife and I got cured from acid reflux by eating those red apples for a few days and the problem never came back.
In Canada they just pass on one doctor to abothwr
I tried to research this topic 10 years ago. Unfortunately, it looks like not much has changed since. Same groping in the dark.
Doctor said 2 options do the operation or take ppi for the rest of my life
my first time hearing about 'indirect' and 'non-acid' reflux. I believe that's what I may have as my throat clearing is almost constant, but all of the tests i've had done reveal normal PH levels and functioning (24 hour Bravo, manometry, barium swallow, multiple EGDs). however, what sort of treatments are there for indirect non-acid reflux? I don't really understand the best next steps.
3:12 I have LPR and gastroparesis. Is it safe to take alginate supplement?
I’ve been dealing with post nasal drip that’s worse in the morning and at night for 2 years. I’ve had two sinus surgeries in my life and I’m allergic to dust mites but I’ve been on allergy shots for the past 4 years. My post nasal drip didn’t start until about 2 years ago or so and I’ve done all I can do as far as ENT and Allergy… Also, I started taking Linzess about 4 years ago as well for chronic constipation… I do suffer from heartburn, regurgitation, and reflux along with the post nasal drip as well. I do have an Endoscopy and Colonoscopy scheduled for April, but I’m trying to see if anyone has had similar symptoms that might be related to taking Linzess…? I’m thinking linzess is causing Gerd/LPR and Gerd/LPR are causing the post nasal drip. Can anybody tell me if Linzess might be the culprit to all these problems?? If anyone experienced the same from Linzess please share. Thank you!
Dr. Jamie Kaufman has changed the term LPR, which she coined, to RR for respiratory reflux.
Koufman never speaks to the matters that Dr. Husein mentions here like indirect reflux. She has become rather a bore. She just laments that nobody listens to her.
@@Fetherko Koufman has spoken at length about indirect reflux although not by that term. I'd never heard that term from Koufman or Aviv or anyone. I just bought a small spray bottle at Koufman suggestion to spray alkaline water in my throat to neutralize pepsin in the voice box. She and Aviv both recommend drinking alkaline water to neutralize pepsin.
They call it different names and they are quite awful and causes a lot of discomforts. They can be cured simply by eating natural remedies such as red apple delicious or Fuji fruits. Eat those red apples for a few days and the problem will go away.
@@Fetherkoshe’s also a business woman….
@@rodrigobalibalita12wtf !?!?!?
Bummed nothing about sleep apnea and LPR correlation. I have both😢
Those questions are very thorough and I really appreciate it.
I don’t have acid coming up but pepsin yes
This is the best video that shows real understanding of LPR
I have been using betaine hcl with better choiced meals. So far so good!
Indirect reflux and neurosensory problems: I have never read this before. It sounds plausible.
I have no idea how to distinguish that from the LPR diagnosis. My ENTs said "red and reflux" when they scoped me. Dr. Husain says that the color indication is subjective.
So now I am stuck with throat clearing at intervals, coughing at intervals and a throat sensation that sometimes makes my right ear pop. (the ear is the asymmetry that she described).
I have improved my gastric function with careful eating and myofascial treatments of the abdomen and thorax. I just don't know what to do.
My symptoms started as completely different globus and loss of appetite and dysphagia. Some swallowing exercises relieved the latter. I think that something refluxed and bombed my pharynx.
I loathe the idea of 24 hour acid monitoring. XR Esophagram and Manometry was ok, although my UES is at the low end of normal at pressure = 35. I think the units are mmHg. That's from memory. My nurse practioner said that both tests were normal. Manometry was normal per some "Chicago scale" criteria. Had one failed swallow and others were 50/50.
Eterna-skeptic Dr. Koufman said that the only test worth doing was XR Esophagram and then in the summer of 2023, she retracted that and said that it was not worth doing. Her advise is to sleep at a 45 degree angle and end use of hundreds of foods and additives. You might feel better in five weeks and if that doesn't work, five months, if you're still not ok , stay on the diet for the rest of your life I suppose. It's gotta work! Have faith! Don't be so cheerless, that also causes reflux.
How are u feeling now
Why impedance instead of Bravo?
Does oesophageal fungus have any bearing on L.P.R.?
Good question
According do the video i have indirect lpr..my throat one side getting inflamed and after that throat is burning for hours..any remedy?
Try eating red apples for a few days and you will see positive results. Red apples are a natural remedy for hyper acidity in the stomach and acid reflux. It works.
Yes, I have LRP, too but diet does not help. Ppi and antacids don’t help, too. Is there no medication?
Gargle alkaline water and baking soda - and change your diet to foods with PH over 5.5 your throat will be better in less than 5 days. -Wipeout reflux diet plan is a course that gives all the info $60 money back not an affiliate. had the same issue
I Have too litle acid and need take pills Shall I use hcl or hcl with pepsin?
Yes or take one tablespoon of apple cider vinegar with an 8 oz glass of lukewarm water on an empty stomach
I just get horse and my nose is stopped up all the time, was told to eliminate acid foods.
For acid reflux you may try eating red apples for a few days.
Does LPR cause the soft palate to have pimple like bumps?
Yes, I have those.
Yes
I was told that I have LPR and my main issue is difficulty swallowing. Of all my research it seems like swallowing difficulty isn't addressed as much as other symptoms but the swallowing problems really affect my quality of life. I've had endoscopies, barium swallow and manometry tests which all come out fine.
I have your same problem, difficulty swallowing, I tried everything the doctors told me to try but no improvement. As you said this problem really affects the quality of life. Have you found any solution? Thanks!
@lgiavatto3072 No I haven't. I can't eat effortlessly like before and things like steak and firm bread trip me up. Softer foods are no problem.
@@lgiavatto3072ko
If all your tests came back positiv then it is strictly psychological and emotional look up Eddie lpr he talks about this.
@@gangstarrr333 Thank you. I will
Is blood in saliva an expected symptom of LPR? Or acid reflux?
I do have blood in saliva in morning too and all the other symptoms of lpr
I have heard that LPR can affect your ears. Can it also affect the eyes?
It's basically ppi for acid reflux and lpr while many is not getting any better. Then surgery will be propose..😢
A natural remedy for acid reflux are red apples. Eat red apples for a few days and you will see positive results. It works.
A very interesting discussion. I didn't recall hearing any mention of LES dysfunction, and in particular the widely-held notion that low stomach acid or high stomach pH can cause the LES to relax. Perhaps this area is the purview of gastroenterology, but it does call into question commonly used acid-reduction therapies, such as ppi's. If strong stomach acid indeed does signal the LES to contract, it would seem that maintaining high acidity is desirable.
Show me any scientific evidence of it
All you need is a simple natural remedy to get rid of hyper-acidity or acid reflux. Eat red apple delicious or Fuji apple fruits for a few days and the problem will go away for good.
Thank you for this information, I will certainly try this.@@rodrigobalibalita12
@@rodrigobalibalita12
I wish it were that easy.
I spit out white stuff every few minutes, it's been going on for 34 years almost. I can feel it comes up from stomach.
Why do non acidic reflux happens? It doesn’t make sense, if non acidic reflux happens but why acid not coming up?
I think non acid reflux just means the pH is less acidic, not that it’s non existent.
My bravo test said no acid found. It doesn’t capture any non acid so no diagnosis
Non acidic digestive enzymes (pepsin for example) , which are not affected by byPPIs, cause LPR symptoms.
Been having globus sensation and feels like food gets stuck in my throat. Only eating purée the past month 😢
Any updates? It’s been 4 days for me.
@@5ermadhow r u now
If you're suffering from acid reflux, you can try eating natural remedies such as red apple delicious or Fuji apple fruits for a few days to get rid of the problem. The treatment worked for us and acid reflux never came back.
Sorry. GI's know nothing about LPR.
My coughing problem occurs mostly at night ( wakes me up wheezing around vocal cords and feeling of crap in upper lungs, then I’m coughing up for about an hour to get it out, it looks like thick white saliva) but this issue only started after a terrible upper respiratory viral infection 2 months ago (not covid). Never smoked, don’t drink alcohol, have stopped drinking coffee, swapped to ginger, cloves cinnamon & honey tea ( homemade). After 3 courses antibiotics, 2 lots of prednisolone, ventolin puffers - drs said I had asthma! Never had asthma in my life. Got tested with X-ray ( nothing in lungs) had full lung function done ( no asthma) all blood tests ruled out legionella and any nasty bugs. now when I lay down I notice coughing is worse , feels around throat and in upper windpipe. Can a virus cause LPR cause I had nothing wrong with me before , gp wants me to start PPI before I see an ENT . Oh pls help as I’m now just taking vitamins, c , d, multi vitamins, short term zinc, changed food by cutting out fats etc , drink lots of water daily, gargling with bicarb drinks daily and iodine gargle ( occasionally) and tried gaviscon (double strength) and sleeping upright on bean bag, but nothing is really helping. What on earth has happened to me ? Any thoughts appreciated.
You may want to consider also checking out Dr. Jamie Koufman’s CZcams channel ….
@@a.i.whitehat1642 thank you
I have had those exact same symptoms. I also had postnasal drip on top of that. It made things worst as I would feel like chocking in the middle of the night. I went to see ENT and he said my throat is inflamed and for postnasal drip he prescribed me two different nasal spray azelastine and Flonase. It helped with my excessive coughing at first as I used it for two months. Then my coughing at night came back and he said that's silent reflux. He just said to use Omeprazole. So I began talking those twice a day and then famotidine at night.. I also drink alkaline water mostly. No tomatoes, no spicy food, no coffee, no onions and garlic and no milk. I believe milk is the worst trigger for me. I had done allergy tests and all came back negative. I tried Gaviscon advanced but none helped. It made my throat even worse. I also take probiotic supplement twice a day. Between all of this and work outs in the morning, I am.90% better than I used to. I can actually sleep and have dreams. I had used inhalers and nebulizer every day before. And it never really helped. With these PPI, famotidine and probiotic helped tremendously. Also drink protein shake once a day to boost protein especially after workout.
@@sgavathe thank you for sharing that, I am glad to hear you feel 90% better and hope you keep getting better. I am now wondering if mine is whooping cough as I am still coughing. I saw an ENT and he reckons my throat looks fine , no polyps or anything abnormal down back of throat and no sign of reflux at all. What a nightmare .
@@la7418 yeah this does sound like a cough that may not be a trigger from reflux. But based on what you said it gets worse at night. That's usually a sign of silent reflux. Your ENT will hopefully help you figure that out.. I would get x-ray for bronchitis or anything like that.
My Gi said no reflux and my ent says LPR
Same been said to me. GI did upper endoscopy. All good there. Ent did say I have reflux.
@@sgavathe same here xD
@@sgavathedid find any cure treatment
@@Michauuhow r u now
They call it different names. Eat red apples for a few days and you will get rid of acid reflux.
For the love of Christ compels us, because we judge thus: that if One died for all, then all died; 15 and He died for all, that those who live should live no longer for themselves, but for Him who died for them and rose again.
16 Therefore, from now on, we regard no one according to the flesh. Even though we have known Christ according to the flesh, yet now we know Him thus no longer. 17 Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new. 18 Now all things are of God, who has reconciled us to Himself through Jesus Christ, and has given us the ministry of reconciliation, 19 that is, that God was in Christ reconciling the world to Himself, not imputing their trespasses to them, and has committed to us the word of reconciliation.
20 Now then, we are ambassadors for Christ, as though God were pleading through us: we implore you on Christ’s behalf, be reconciled to God. 21 For He made Him who knew no sin to be sin for us, that we might become the righteousness of God in Him. 2 Corinthians 5:14-21
Not helpful
Gargle alkaline water and baking soda - and change your diet to foods with PH over 5.5 your throat will be better in less than 5 days. -Wipeout reflux diet plan is a course that gives all the info $60 money back not an affiliate. had the same issue
Here is the exact cure folks if you have LPR
Zero surgeries zero meds.
If you have lump in your throat - problem swallowing. Food feels like it gets stuck in the base of your throat. Burps and lots of pressure on your stomach.
Gargle alkaline water (PH 9.5) is fine and 1 tablespoon regular baking soda in the back of your throat.
After every meal if severe - I still do it 2x a day.
You will instantly feel better and in 2-3 days probably 75-80 percent. (yes, pepsin is the issue)
Eliminate all high acidic foods. Eat foods with a 5.5+ PH level.
Single ingredient foods only - zero preservatives
Wipeout reflux diet plan - its $60 something dollar course I stumbled on with the diet and a million people who went through all the steps.
You also need to manage you stress, eating upright, not before bed,
there's phases
You can basically eat - Bananas, watermelon, cantaloupe, avocados, chicken, turkey, beef, spinach , eggs, some lettuce, butter, salt, olive oil, potatoes, probably more Im forgetting.
when you move forward bread, maple syrup, rice, mozzarella cheese a few others. Course shares all..
$70 for your entire cure.
Overtime it should cure you...
I got way better and do the diet but still eat ice cream like 5 days a week.
I'm comfortable.
If I go back to old I still need to clear my throat - or can get burps.
You're supposed to be disciplined to see it through. Many are all the way back to normal..
Experimented on myself for 2 months.
Good luck, Promise its the way!
I also do natural method youtube 3 minute throat massage this whole time so that mighve had a factor as well.
"how to naturally prevent LPR the silent reflux...
How do you do the throat massage?
@@JoeS97756 CZcams “how to naturally prevent LPR the silent reflux in just 3 minutes”. This with a disciplined diet and baking soda gargle and I had no throat pain. I’ve self destructed a few times with stints of ice cream or some other foods, which has given me spurts Of minor discomfort. So I can’t say if you heal 100% and resume normal habits. I’m trying again to go all the way. Just hard to eat bare bones foods for the time being
@@Zackkruppthanks